Nonmetastatic gestational trophoblastic neoplasia. Role of ultrasonography and magnetic resonance imaging.
OBJECTIVE
To determine whether routine imaging using grey-scale ultrasound, pulse and color Doppler flow, endovaginal ultrasound and magnetic resonance imaging (MRI) provide information that significantly helps determine therapy in patients with nonmetastatic gestational trophoblastic disease.


METHODS
A literature search was performed to seek all publications in English and German that reported on investigations of imaging by ultrasound and MRI in patients with a diagnosis of trophoblastic tumor without evidence of metastases. Studies performed to make a diagnosis of hydatidiform mole were excluded. Included were studies that investigated the clinical usefulness and efficacy of these imaging methods in the diagnosis of invasive mole as a visual confirmation of the diagnosis based on human chorionic gonadotropin (hCG) and histology. Furthermore, the usefulness and efficiency of imaging in determining the effectiveness of chemotherapy were investigated.


RESULTS
Analysis of these reports showed that lesions are detectable by imaging modalities at relatively high levels of hCG but may not be visualized at lower levels of hCG, when chemotherapy is nevertheless indicated and the diagnosis of neoplasia is fully justified. Moreover, myometrial lesions have been observed by MRI in patients who subsequently achieved spontaneous resolution of their disease without chemotherapy. At lower levels of hCG (< 700 mIU/mL), intramyometrial lesions may not be visualized by either ultrasound or MRI. Myometrial abnormalities may persist with resolution of the tumor. Thus, the sensitivity of either method is no better than 70% and the specificity is even lower.


CONCLUSIONS
Weekly serial levels of serum hCG remain the most accurate, reliable and definitive arbiter of treatment management. Pelvic ultrasound or MRI need not be an integral part of pretreatment assessment. Imaging techniques are expensive yet not decisive in managing nonmetastatic trophoblastic disease. This finding applies to nonmetastatic disease only. With metastases, ultrasound, MRI and computed tomography do play an integral role in diagnosis, staging and management.
Kohorn
E I
EI
Department of Obstetrics and Gynecology, and Diagnostic Imaging, Yale University School of Medicine, New Haven, Connecticut 06520-8063, USA.
McCarthy
S M
SM
Taylor
K J
KJ
D006063:Chorionic Gonadotropin / Q000097:blood* / Q000378:metabolism; D005260:Female; D005865:Gestational Age; D006801:Humans; D006828:Hydatidiform Mole / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008279:Magnetic Resonance Imaging; D009215:Myometrium / Q000000981:diagnostic imaging / Q000473:pathology; D011247:Pregnancy; D018615:Ultrasonography, Doppler, Color; D014594:Uterine Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging
D006063:Chorionic Gonadotropin